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Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding
Background Measuring the portal pressure gradient from the portal vein (PV) to the inferior vena cava (IVC) or to the right atrium (RA) remains controversial. The aim of our study was to compare the predictive ability of portoatrial gradient (PAG) and portocaval gradient (PCG) for variceal rebleedin...
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| Published in: | Journal of gastroenterology 2023-05, Vol.58 (5), p.494-502 |
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| container_title | Journal of gastroenterology |
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| creator | Ma, Li Liu, Yaozu Yan, Zhiping Zhang, Wen Zhang, Zihan Yang, Minjie Yu, Jiaze Zhou, Xin Chen, Shiyao Wang, Jian Ma, Jingqin Luo, Jianjun |
| description | Background
Measuring the portal pressure gradient from the portal vein (PV) to the inferior vena cava (IVC) or to the right atrium (RA) remains controversial. The aim of our study was to compare the predictive ability of portoatrial gradient (PAG) and portocaval gradient (PCG) for variceal rebleeding.
Methods
The data of 285 cirrhotic patients with variceal bleeding undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) in our hospital were analyzed retrospectively. The variceal rebleeding rates were compared between groups categorized by established or modified thresholds. The median follow-up time was 30.0 months.
Results
After TIPS, PAG was equal to (
n
= 115) or more than (
n
= 170) PCG. The pressure of IVC was defined as an independent predictor for a PAG-PCG difference of ≥ 2 mmHg (
p
|
| doi_str_mv | 10.1007/s00535-023-01977-w |
| format | article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2785199141</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A747336505</galeid><sourcerecordid>A747336505</sourcerecordid><originalsourceid>FETCH-LOGICAL-c466t-82661d49691797febe3dc9609a94d54b43d90e09166a6c29cc8c98260497d6623</originalsourceid><addsrcrecordid>eNp9Us2OFCEYJEbjjqMv4MGQePHSKzQ0NMfNxL9kEy96JjT9dQ-THmiBns28iw8rY69uNMZwIPVRVSmgEHpJyTUlRL5NhDSsqUjNKkKVlNXdI7ShvIwaVdeP0YYozitKJb9Cz1I6EEIZadqn6IqJVtWCtRv0fReOs4nOjzjvAc8RemezOwE2nZtcPuMw4DnEHEyOzkzY-H7F1pwKHKPpHfiMzZAh4hyNT4dlXCYTsfMF7mE22dlVk84pw7GgtF-KxkYoZ8HjIUR8KiksFMsI3QQlhh-foyeDmRK8uN-36Ov7d192H6vbzx8-7W5uK8uFyFVbC0F7roSiUskBOmC9VYIoo3jf8I6zXhEgigphhK2Vta1VRUS4kr0QNduiN6vvHMO3BVLWR5csTJPxEJaka9k2VCnKaaG-_ot6CEv0JZ2uW0WYkFLIB9ZoJtDOD6G8hL2Y6hvJJWOiKV-3Rdf_YJXVX94oeBhcmf8hqFeBjSGlCIOeozuaeNaU6Esl9FoJXSqhf1ZC3xXRq_vES3eE_rfkVwcKga2ENF96APHhSv-x_QGDvsQV</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2890367767</pqid></control><display><type>article</type><title>Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding</title><source>Springer Link</source><creator>Ma, Li ; Liu, Yaozu ; Yan, Zhiping ; Zhang, Wen ; Zhang, Zihan ; Yang, Minjie ; Yu, Jiaze ; Zhou, Xin ; Chen, Shiyao ; Wang, Jian ; Ma, Jingqin ; Luo, Jianjun</creator><creatorcontrib>Ma, Li ; Liu, Yaozu ; Yan, Zhiping ; Zhang, Wen ; Zhang, Zihan ; Yang, Minjie ; Yu, Jiaze ; Zhou, Xin ; Chen, Shiyao ; Wang, Jian ; Ma, Jingqin ; Luo, Jianjun</creatorcontrib><description>Background
Measuring the portal pressure gradient from the portal vein (PV) to the inferior vena cava (IVC) or to the right atrium (RA) remains controversial. The aim of our study was to compare the predictive ability of portoatrial gradient (PAG) and portocaval gradient (PCG) for variceal rebleeding.
Methods
The data of 285 cirrhotic patients with variceal bleeding undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) in our hospital were analyzed retrospectively. The variceal rebleeding rates were compared between groups categorized by established or modified thresholds. The median follow-up time was 30.0 months.
Results
After TIPS, PAG was equal to (
n
= 115) or more than (
n
= 170) PCG. The pressure of IVC was defined as an independent predictor for a PAG-PCG difference of ≥ 2 mmHg (
p
< 0.001, OR 1.23, 95% CI 1.10–1.37). Using a threshold of 12 mmHg, PAG (
p
= 0.081, HR 0.63, 95% CI 0.37–1.06) could not predict variceal rebleeding but PCG could (
p
= 0.003, HR 0.45, 95% CI 0.26–0.77). This pattern was unchanged when a ≥ 50% reduction from baseline was also considered as a threshold (PAG/PCG:
p
= 0.114 and 0.001). Subgroup analyses showed that only in patients with post-TIPS IVC pressure < 9 mmHg (
p
= 0.018), PAG could predict variceal rebleeding. Because PAG was on average 1.4 mmHg higher than PCG, patients were classified by a PAG of 14 mmHg, and there was no difference in rebleeding rates between these two groups (
p
= 0.574).
Conclusions
For patients with variceal bleeding, the predictive ability of PAG is limited. The portal pressure gradient should be measured between the PV and IVC.</description><identifier>ISSN: 0944-1174</identifier><identifier>EISSN: 1435-5922</identifier><identifier>DOI: 10.1007/s00535-023-01977-w</identifier><identifier>PMID: 36892638</identifier><language>eng</language><publisher>Singapore: Springer Nature Singapore</publisher><subject>Abdomen ; Abdominal Surgery ; Biliary Tract ; Bleeding ; Catheters ; Colorectal Surgery ; Comparative analysis ; Esophageal and Gastric Varices - etiology ; Esophageal and Gastric Varices - surgery ; Gastroenterology ; Gastrointestinal Hemorrhage - etiology ; Gastrointestinal Hemorrhage - surgery ; Hepatology ; Hospitals ; Humans ; Liver cirrhosis ; Liver Cirrhosis - complications ; Liver diseases ; Local anesthesia ; Medicine ; Medicine & Public Health ; Original Article―Liver ; Pancreas ; Patients ; Portal vein ; Portal Vein - surgery ; Portasystemic Shunt, Transjugular Intrahepatic - adverse effects ; Retrospective Studies ; Statistical analysis ; Stents ; Surgical Oncology ; Treatment Outcome</subject><ispartof>Journal of gastroenterology, 2023-05, Vol.58 (5), p.494-502</ispartof><rights>Japanese Society of Gastroenterology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. Japanese Society of Gastroenterology.</rights><rights>COPYRIGHT 2023 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-82661d49691797febe3dc9609a94d54b43d90e09166a6c29cc8c98260497d6623</citedby><cites>FETCH-LOGICAL-c466t-82661d49691797febe3dc9609a94d54b43d90e09166a6c29cc8c98260497d6623</cites><orcidid>0000-0003-4942-0439</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36892638$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ma, Li</creatorcontrib><creatorcontrib>Liu, Yaozu</creatorcontrib><creatorcontrib>Yan, Zhiping</creatorcontrib><creatorcontrib>Zhang, Wen</creatorcontrib><creatorcontrib>Zhang, Zihan</creatorcontrib><creatorcontrib>Yang, Minjie</creatorcontrib><creatorcontrib>Yu, Jiaze</creatorcontrib><creatorcontrib>Zhou, Xin</creatorcontrib><creatorcontrib>Chen, Shiyao</creatorcontrib><creatorcontrib>Wang, Jian</creatorcontrib><creatorcontrib>Ma, Jingqin</creatorcontrib><creatorcontrib>Luo, Jianjun</creatorcontrib><title>Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding</title><title>Journal of gastroenterology</title><addtitle>J Gastroenterol</addtitle><addtitle>J Gastroenterol</addtitle><description>Background
Measuring the portal pressure gradient from the portal vein (PV) to the inferior vena cava (IVC) or to the right atrium (RA) remains controversial. The aim of our study was to compare the predictive ability of portoatrial gradient (PAG) and portocaval gradient (PCG) for variceal rebleeding.
Methods
The data of 285 cirrhotic patients with variceal bleeding undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) in our hospital were analyzed retrospectively. The variceal rebleeding rates were compared between groups categorized by established or modified thresholds. The median follow-up time was 30.0 months.
Results
After TIPS, PAG was equal to (
n
= 115) or more than (
n
= 170) PCG. The pressure of IVC was defined as an independent predictor for a PAG-PCG difference of ≥ 2 mmHg (
p
< 0.001, OR 1.23, 95% CI 1.10–1.37). Using a threshold of 12 mmHg, PAG (
p
= 0.081, HR 0.63, 95% CI 0.37–1.06) could not predict variceal rebleeding but PCG could (
p
= 0.003, HR 0.45, 95% CI 0.26–0.77). This pattern was unchanged when a ≥ 50% reduction from baseline was also considered as a threshold (PAG/PCG:
p
= 0.114 and 0.001). Subgroup analyses showed that only in patients with post-TIPS IVC pressure < 9 mmHg (
p
= 0.018), PAG could predict variceal rebleeding. Because PAG was on average 1.4 mmHg higher than PCG, patients were classified by a PAG of 14 mmHg, and there was no difference in rebleeding rates between these two groups (
p
= 0.574).
Conclusions
For patients with variceal bleeding, the predictive ability of PAG is limited. The portal pressure gradient should be measured between the PV and IVC.</description><subject>Abdomen</subject><subject>Abdominal Surgery</subject><subject>Biliary Tract</subject><subject>Bleeding</subject><subject>Catheters</subject><subject>Colorectal Surgery</subject><subject>Comparative analysis</subject><subject>Esophageal and Gastric Varices - etiology</subject><subject>Esophageal and Gastric Varices - surgery</subject><subject>Gastroenterology</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Gastrointestinal Hemorrhage - surgery</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver diseases</subject><subject>Local anesthesia</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article―Liver</subject><subject>Pancreas</subject><subject>Patients</subject><subject>Portal vein</subject><subject>Portal Vein - surgery</subject><subject>Portasystemic Shunt, Transjugular Intrahepatic - adverse effects</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Stents</subject><subject>Surgical Oncology</subject><subject>Treatment Outcome</subject><issn>0944-1174</issn><issn>1435-5922</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9Us2OFCEYJEbjjqMv4MGQePHSKzQ0NMfNxL9kEy96JjT9dQ-THmiBns28iw8rY69uNMZwIPVRVSmgEHpJyTUlRL5NhDSsqUjNKkKVlNXdI7ShvIwaVdeP0YYozitKJb9Cz1I6EEIZadqn6IqJVtWCtRv0fReOs4nOjzjvAc8RemezOwE2nZtcPuMw4DnEHEyOzkzY-H7F1pwKHKPpHfiMzZAh4hyNT4dlXCYTsfMF7mE22dlVk84pw7GgtF-KxkYoZ8HjIUR8KiksFMsI3QQlhh-foyeDmRK8uN-36Ov7d192H6vbzx8-7W5uK8uFyFVbC0F7roSiUskBOmC9VYIoo3jf8I6zXhEgigphhK2Vta1VRUS4kr0QNduiN6vvHMO3BVLWR5csTJPxEJaka9k2VCnKaaG-_ot6CEv0JZ2uW0WYkFLIB9ZoJtDOD6G8hL2Y6hvJJWOiKV-3Rdf_YJXVX94oeBhcmf8hqFeBjSGlCIOeozuaeNaU6Esl9FoJXSqhf1ZC3xXRq_vES3eE_rfkVwcKga2ENF96APHhSv-x_QGDvsQV</recordid><startdate>20230501</startdate><enddate>20230501</enddate><creator>Ma, Li</creator><creator>Liu, Yaozu</creator><creator>Yan, Zhiping</creator><creator>Zhang, Wen</creator><creator>Zhang, Zihan</creator><creator>Yang, Minjie</creator><creator>Yu, Jiaze</creator><creator>Zhou, Xin</creator><creator>Chen, Shiyao</creator><creator>Wang, Jian</creator><creator>Ma, Jingqin</creator><creator>Luo, Jianjun</creator><general>Springer Nature Singapore</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4942-0439</orcidid></search><sort><creationdate>20230501</creationdate><title>Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding</title><author>Ma, Li ; Liu, Yaozu ; Yan, Zhiping ; Zhang, Wen ; Zhang, Zihan ; Yang, Minjie ; Yu, Jiaze ; Zhou, Xin ; Chen, Shiyao ; Wang, Jian ; Ma, Jingqin ; Luo, Jianjun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-82661d49691797febe3dc9609a94d54b43d90e09166a6c29cc8c98260497d6623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdomen</topic><topic>Abdominal Surgery</topic><topic>Biliary Tract</topic><topic>Bleeding</topic><topic>Catheters</topic><topic>Colorectal Surgery</topic><topic>Comparative analysis</topic><topic>Esophageal and Gastric Varices - etiology</topic><topic>Esophageal and Gastric Varices - surgery</topic><topic>Gastroenterology</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Gastrointestinal Hemorrhage - surgery</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver diseases</topic><topic>Local anesthesia</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article―Liver</topic><topic>Pancreas</topic><topic>Patients</topic><topic>Portal vein</topic><topic>Portal Vein - surgery</topic><topic>Portasystemic Shunt, Transjugular Intrahepatic - adverse effects</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Stents</topic><topic>Surgical Oncology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ma, Li</creatorcontrib><creatorcontrib>Liu, Yaozu</creatorcontrib><creatorcontrib>Yan, Zhiping</creatorcontrib><creatorcontrib>Zhang, Wen</creatorcontrib><creatorcontrib>Zhang, Zihan</creatorcontrib><creatorcontrib>Yang, Minjie</creatorcontrib><creatorcontrib>Yu, Jiaze</creatorcontrib><creatorcontrib>Zhou, Xin</creatorcontrib><creatorcontrib>Chen, Shiyao</creatorcontrib><creatorcontrib>Wang, Jian</creatorcontrib><creatorcontrib>Ma, Jingqin</creatorcontrib><creatorcontrib>Luo, Jianjun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ma, Li</au><au>Liu, Yaozu</au><au>Yan, Zhiping</au><au>Zhang, Wen</au><au>Zhang, Zihan</au><au>Yang, Minjie</au><au>Yu, Jiaze</au><au>Zhou, Xin</au><au>Chen, Shiyao</au><au>Wang, Jian</au><au>Ma, Jingqin</au><au>Luo, Jianjun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding</atitle><jtitle>Journal of gastroenterology</jtitle><stitle>J Gastroenterol</stitle><addtitle>J Gastroenterol</addtitle><date>2023-05-01</date><risdate>2023</risdate><volume>58</volume><issue>5</issue><spage>494</spage><epage>502</epage><pages>494-502</pages><issn>0944-1174</issn><eissn>1435-5922</eissn><abstract>Background
Measuring the portal pressure gradient from the portal vein (PV) to the inferior vena cava (IVC) or to the right atrium (RA) remains controversial. The aim of our study was to compare the predictive ability of portoatrial gradient (PAG) and portocaval gradient (PCG) for variceal rebleeding.
Methods
The data of 285 cirrhotic patients with variceal bleeding undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) in our hospital were analyzed retrospectively. The variceal rebleeding rates were compared between groups categorized by established or modified thresholds. The median follow-up time was 30.0 months.
Results
After TIPS, PAG was equal to (
n
= 115) or more than (
n
= 170) PCG. The pressure of IVC was defined as an independent predictor for a PAG-PCG difference of ≥ 2 mmHg (
p
< 0.001, OR 1.23, 95% CI 1.10–1.37). Using a threshold of 12 mmHg, PAG (
p
= 0.081, HR 0.63, 95% CI 0.37–1.06) could not predict variceal rebleeding but PCG could (
p
= 0.003, HR 0.45, 95% CI 0.26–0.77). This pattern was unchanged when a ≥ 50% reduction from baseline was also considered as a threshold (PAG/PCG:
p
= 0.114 and 0.001). Subgroup analyses showed that only in patients with post-TIPS IVC pressure < 9 mmHg (
p
= 0.018), PAG could predict variceal rebleeding. Because PAG was on average 1.4 mmHg higher than PCG, patients were classified by a PAG of 14 mmHg, and there was no difference in rebleeding rates between these two groups (
p
= 0.574).
Conclusions
For patients with variceal bleeding, the predictive ability of PAG is limited. The portal pressure gradient should be measured between the PV and IVC.</abstract><cop>Singapore</cop><pub>Springer Nature Singapore</pub><pmid>36892638</pmid><doi>10.1007/s00535-023-01977-w</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-4942-0439</orcidid></addata></record> |
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| ispartof | Journal of gastroenterology, 2023-05, Vol.58 (5), p.494-502 |
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| source | Springer Link |
| subjects | Abdomen Abdominal Surgery Biliary Tract Bleeding Catheters Colorectal Surgery Comparative analysis Esophageal and Gastric Varices - etiology Esophageal and Gastric Varices - surgery Gastroenterology Gastrointestinal Hemorrhage - etiology Gastrointestinal Hemorrhage - surgery Hepatology Hospitals Humans Liver cirrhosis Liver Cirrhosis - complications Liver diseases Local anesthesia Medicine Medicine & Public Health Original Article―Liver Pancreas Patients Portal vein Portal Vein - surgery Portasystemic Shunt, Transjugular Intrahepatic - adverse effects Retrospective Studies Statistical analysis Stents Surgical Oncology Treatment Outcome |
| title | Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding |
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